APA Asks Congress to Drop Patient Medical Identifiers

APA has urged members of Congress to repeal a 1996 federal law that would require every American to be assigned a medical identification number or prohibit its implementation. At press time, APA was hopeful that the chairs of the House and Senate Appropriations subcommittees would not fund federal agency actions aimed at implementing the law including regulations in Fiscal 1999.

APA also submitted a written statement to the House Subcommittee on National Economic Growth, Natural Resources, and Regulatory Affairs, which held a hearing in September on national identification numbers.

"We believe creating a national identifier would irreparably harm Americans' privacy and undermine the high-quality health care Americans receive," according to the statement.

"A national identifier would facilitate disclosures, including access without patient consent by health plans, life and health insurers, employers, credit card companies, and others, of our most personal medical information," APA testified.

Moreover, "It would also likely lead to the establishment of a national medical record database containing information on all Americans and perhaps a national medical identification card. Under these circumstances, it would be much easier for many government agencies, including law enforcement, to gain access to our most personal medical information," according to the statement.

APA President Rodrigo Muņoz, M.D., commented to Psychiatric News, "We are trying to balance the right of our patients to privacy and confidentiality against the right of the government to do epidemiological studies with their medical information. Health and research activities need to be tempered with the protections our patients deserve."

According to William Bruno, an associate director of APA's Division of Government Relations, members of Congress and the public have strongly opposed the federal government's creation of a national medical identifier system because of concerns about inappropriate uses of the information. The identifier provision is part of the Health Information Portability and Accountability Act (HIPAA) enacted in 1996.

APA Vice President Richard Harding, M.D., who is a member of but not the official spokesperson for the National Committee on Vital and Health Statistics, told Psychiatric News that the committee was charged with advising Secretary Donna Shalala of the Department of Health and Human Services (HHS) on the patient identifier issue. However, Gore told the committee, which began its hearings this summer, to proceed no further.

"Gore said he and the [Clinton] administration are concerned about the great sensitivity surrounding the medical identifier," said Harding. "Gore also said that the committee should delay its hearings until there is responsible privacy legislation."

Congress is required under HIPAA to implement comprehensive confidentiality legislation by next August.

Harding commented on the concerns expressed by many privacy and advocacy groups about the "unique patient identifier."

"Although the 1996 legislation doesn't specifically authorize the creation of a national medical database, citizens are deeply concerned about the ability to track medical encounters from birth to death in one medical account."

Supporters emphasize that a national patient identifier has the potential to advance public health, medical, and research interests, noted Harding. However, opponents emphasize the potential misuse of such information for discriminatory purposes such as denial of promotions and health insurance, said Harding.

Notwithstanding the temporary lull in committee hearings, there is still a requirement to implement the medical identifier. APA is urging Congress to repeal the medical identifier provision and support legislation (the Patient Privacy Act) introduced by Rep. Ron Paul (R-Tex.) and Sen. Patrick Leahy (D-Vt.) that would accomplish that.

Muņoz wrote Paul and Leahy in July that APA believes "your effort represents an important first step toward protecting individual liberty, personal privacy, and the confidentiality of the doctor-patient relationship that is so necessary for high-quality medical care."

Paul also urged the House subcommittee at its September hearing to support his legislation. "The only solution to the threat to liberty created by the medical I.D. proposal is simply to repeal the provisions of law authorizing the identifiers," stated Paul's written testimony.

At a minimum, APA recommends that Congress should be legally required to hold an affirmative vote on the provision before it is implemented, according to APA's statement.

APA also drew the subcommittee's attention to new federal regulatory actions that undermine individual privacy and the quality of health care. "We hope that you will take decisive actions to block these new regulations," urges APA's statement.

• Medicare Plus Choice regulations, which become effective January 1, 1999, will allow senior citizens' medical records to be disseminated without patient consent to many individuals in and outside of managed care organizations including bill collection agencies or companies that would use the information for marketing or other commercial purposes.



• HHS and Department of Justice regulations would allow federal authorities and ultimately local government and police to have routine access to medical records under the Privacy Act of 1974 to combat fraud. Officials would be able to see highly personal medical data including those for mental health care. There are no effective limits on secondary use and disclosure of this information.

"The cumulative effect of these regulations as well as the general erosion of medical privacy is that Americans will become increasingly suspicious of the health care system. Patients realize they have little assurance that their medical records will remain confidential. Under these circumstances, patients will be less likely to provide the full information that doctors need to treat them effectively," according to APA's statement.